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SOS Referral Form - For Parents and Peers
Abilene Christian University
(
*
indicates a required field.)
1). Student's name and Banner ID:
*
2). Referred By:
*
3). Telephone:
4). E-mail address:
5). Academic Issues:
Grades
Homework
Attendance
Transferring/Withdrawing
Other (please explain below)
6). Physical/Mental Health Issues:
Illness
Needs Encouragement
Adjustment/Personal Issues
Test Anxiety
Other (please explain below)
7). Major/Career Issues:
Undecided Major
Unsuitable Major
Internship or Practicum Placement Issues
Other (please explain below)
8). Other Issues:
Crisis at Home
Financial
Residential
Chapel Attendance
Other (please explain below)
9). Action(s) Taken to Date:
E-mailed Student
Talked With Student After Class
Requested a Meeting With Student
Other (please explain below)
10). Comments:
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